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Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

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Revision Rhinoplasty NYC

Before and After Revision Rhinoplasty *Results may vary. View More Photos
Female patient Before and After Revision Rhinoplasty *Results may vary. View More Photos

A rhinoplasty procedure in New York City is among the most complex plastic surgeries, requiring a great deal of precision and artistry during the entire process. That is why the price of revision rhinoplasty in NYC exceeds most other procedures. Fortunately, there are surgeons such as Dr. Rizk who are highly trained and experienced in not only sculpting the natural appearance of the nose, but also in ensuring its optimal function.

Defining Revision Rhinoplasty

Revision rhinoplasty is a procedure done to correct aesthetic or functional issues as well as deformities following primary or secondary rhinoplasty surgery. During a revision rhinoplasty in New York, Dr. Rizk's main goal is to provide patients with the results they expected the first time around. When patients research a revision rhinoplasty surgeon, they are naturally more wary because of their previous bad experience with the procedure. Dr. Rizk understands this, and is committed to providing patients with all of the information required to make an educated, confident decision.

Identifying Cases that Require Revision Rhinoplasty in NYC

Cosmetic surgery techniques in relation to rhinoplasty have made great advancements over the past few decades. Older rhinoplasty techniques often left patients with difficulties leading to nasal or septum collapse. Dr. Rizk is a double-board certified facial plastic surgeon that specializes in procedures of the face and nose, providing custom results that support the natural structure of the nose and compliment your appearance.

Revision rhinoplasty is vastly more complex in nature due to the excess scar tissue and advanced structural changes not present during primary surgeries. Dr. Rizk’s additional certification in otolaryngology helps ensure the structure and natural function of the nose is preserved, while simultaneously fixing cosmetic issues during revision rhinoplasty in New York City .

Common Anatomic Problems Corrected with Revision Rhinoplasty

Dr. Rizk has identified the following anatomical abnormalities typically found in revision/secondary rhinoplasty:

  • Functional breathing deficit resulting from an overaggressive rhinoplasty
  • Asymmetries or a deviated/crooked nose
  • Areas of collapse after overcorrection or an overly aggressive rhinoplasty
  • Areas of undercorrection in the area above the tip, called a pollybeak deformity
  • Drooping of the nasal tip after not supporting it in the first operation with cartilage grafts if the tip had weak support from the beginning
  • Hanging columella (the middle-center piece of skin in the nose separating the right and left nostrils)
  • Pinched tip resulting from over resection of the tip cartilage
  • Saddle nose deformity (scooped nose) resulting from over resection of the nasal dorsum or bridge (cartilage and bone)
  • Inverted V deformity resulting from over resection of the cartilage that forms the sides of the bridge of the nose (called upper lateral cartilages)

Dr. Rizk's Unique Approach To Revision Rhinoplasty in New York

With the help of cutting edge imaging software, Dr. Rizk provides patients with a visual example of the possible aesthetic changes that can be made with surgery. An educated patient is a happy patient, so at the earliest stage of the process you can continuously review the planned changes to your nose and offer input. Once the patient and Dr. Rizk are satisfied with the programmed surgical outcome, the double-board certified NYC facial plastic surgeon will proceed with surgery.

Dr. Rizk has two innovations that allow for more precise, natural results in revision rhinoplasty. First, a 3D high-definition telescope/camera system pioneered by Dr. Rizk, is used during the revision rhinoplasty to view the nasal bridge (dorsum) and to modify it more accurately. Second, as most revision rhinoplasty surgeries resulting from over resection of tissue will require cartilage grafts, Dr. Rizk has developed a method of better sculpting cartilage grafts or nasal implants to create smooth, natural looking edges.

Unlike other specialists, Dr. Rizk does not believe in a one-size-fits-all rhinoplasty approach. He tailors each procedure based on your aesthetic concerns and desired outcome.

Dr. Rizk Featured on Tatler's Beauty

Dr. Rizk Featured on Tatler's Beauty & Cosmetic Surgery Guide

Dr. Rizk Featured on About.com - Luxury Travel Meets Medical Tourism

Dr. Rizk Featured on About.com - Luxury Travel Meets Medical Tourism

Why Is Revision Rhinoplasty Surgery Complicated?

Patients undergoing secondary or revision rhinoplasty in New York City have nasal anatomic characteristics that are different and more complex than primary rhinoplasty, which require special attention to detail and specialized techniques during the procedure.

In secondary rhinoplasty, the tissue inside the nose has undergone changes and may not tolerate extensive dissection, thinning procedures, or multiple incisions. Some noses have very thin skin and extensive scar tissue inside. The skin in revision rhinoplasty is not as pliable, which means that it does not easily tolerate expansion or contraction.

Therefore, the rhinoplasty surgeon must use specialized techniques to effect a change in the structure of the nose to overcome the scar tissue. Dr. Rizk uses suture and cartilage graft methods to create tension greater than that exerted by the scar tissue and skin envelope. This translates into greater resistance and change in the structure of the nose.

These conservative suture and grafting techniques are far superior in revision rhinoplasty than excisional techniques, usually performed in primary procedures. While there are exceptions to this rule, for example in cases where a nasal bump has not been adequately reduced, more often than not a revision or secondary rhinoplasty becomes necessary when too much has been removed from the nose in the initial operation and it starts to collapse. In these cases, the nose becomes scooped (saddle nose deformity) and the patient starts to experience difficulty breathing through the nose.

Some revision rhinoplasty patients require dorsal or maxillary augmentation with either a dorsal onlay graft or a plumping graft. A scooped nose can be a significant stigma to the patient and can make a male patient look more feminine. Dr. Rizk prefers to use either the patient's own (autogenous) cartilage or, for patients with thick skin, he prefers Medpor implants for augmentation rhinoplasty.

Why is Surgical Planning Important?

Surgical planning is important in revision or secondary rhinoplasty in order to confirm the best technique for the case. Both endonasal and open rhinoplasty approaches have a role in revision rhinoplasty, depending on the deformity.

The open approach is advocated if there is complicated and distorted anatomy or significant asymmetry or lack of tip support. The endonasal technique is often useful as well and allows precise placement of cartilage pockets to place grafts to correct areas of collapse. This technique in revision rhinoplasty is also a minimally invasive approach to correct a pollybeak deformity.

If a pollybeak, or excessive cartilage, exists in the area above the tip, this is easily correctable with an endonasal intercartilaginous incision to expose the dorsum. The advantage of the endonasal approach in revision rhinoplasty is that it is minimally invasive and results in decreased scar tissue formation and better healing.

Considering Cartilage Depletion

Typically, most secondary rhinoplasty patients have already undergone a few rhinoplasty procedures and may have cartilage depletion or a lack of cartilage in their nose after a previous septoplasty. This is an important point as Dr. Rizk believes it is necessary to try to obtain cartilage from a donor site such as the ear (concha grafts) or rib cartilage from a rib bank. He states that surgeons who expect to achieve an excellent outcome with revision or secondary rhinoplasty must try to obtain septal, ear, or rib cartilage for nasal reconstruction. However, should that not be possible, Dr. Rizk also uses alloplastic biosynthetic nasal implants to rebuild a collapsed nose depending on the case.

Understanding the Psychology Behind Revision Rhinoplasty

It is important to understand the psychology of secondary rhinoplasty patients who have been disappointed with their previous rhinoplasty procedures and have less tolerance for postoperative problems. Patients also may feel guilty that they did not provide enough information to the surgeon, did not ask enough questions, did not do enough research into the surgeon's qualifications, or did not communicate their desires correctly to the surgeon. This guilt may increase the patient's anxiety about the secondary rhinoplasty procedure.

In addition, in revision rhinoplasty it is necessary to assess patient motivation. Dr. Rizk points out that there are many types of patients who consider the procedure. The continuum ranges from patients with poor results that seek improvement but like their previous surgeons, to patients with objectively good results but who are desperately unhappy and furious with their first plastic surgeon.

Preoperative photography and thorough interviews with the revision rhinoplasty patient are imperative. It is also important to distinguish patient anger toward their previous surgeon from disappointment with an outcome the patient didn’t expect. Most surgeons’ intentions are to do their best to help their patients. Dr. Rizk reminds patients of this fact to try to diffuse their anger.

Dr. Rizk does not operate on angry patients and he attempts to convert an angry patient's attitude towards their previous surgeon from that of resentment to one of disappointment. Patients must understand the margin of error inherent in human surgery and healing. All patients must understand that perfection is unattainable in revision rhinoplasty and any patient seeking perfect results is not considered a good candidate for revision rhinoplasty by Dr. Rizk. Additionally, patients with body dysmorphic disorder who continually seek cosmetic surgery are not good candidates for revision rhinoplasty in NYC.

Alar Base Surgery in Revision Rhinoplasty

Most patients and surgeons evaluate alar base width as either normal or wide. However, Dr. Rizk states that this part of your nose can also be too narrow from a previous surgery, though narrow bases occur less commonly in primary rhinoplasty. Medial displacement of the base can occur on the cleft side after lip repair or after alar wedge resection in revision rhinoplasty.

Aesthetic measurements dictate alar base width should equal intercanthal distance. Composite grafts, using the alar lobule or the ear as a donor site, can be used to properly position the nostril or vestibular stenosis in the nose. In some scenarios, both nostril stenosis and malposition of the alar base exists.

Repairing a Drooping Nasal Tip

In cases where the tip has dropped, it is necessary to use a support graft. Sometimes, a columellar strut, shield graft, a plumping graft, caudal septal extension graft, or a combination of the above is needed to correct the tip ptosis, lengthening of the nose and maxillary recession that occurs when tip support is lost.

By lifting and supporting the nasal tip to the proper position, a person can appear more youthful. To obtain cartilage for such an endeavor, it is necessary to look for a donor site either from the septum, ear, or from banked rib cartilage. When over aggressive septal surgery or nasal surgery is performed, the entire nasal base can drop inferiorly and lengthen the nose. Maxillary arch retrusion can occur and can be corrected with maxillary augmentation. Loss of support to the tip of the nose requires support of the nasal base or caudal septum or nasal tip. Either rib cartilage or septum cartilage is used for tip support because ear cartilage has insufficient strength and the wrong shape for this type of support.

Patients With Nasal Bridge Deformities

In patients with dorsal (bridge of the nose) deformities, it is important to understand that dorsal resection affects nasal balance, nasal base size, width, middle vault width, columellar position, and nostril contour. The degree of change depends on how aggressive the surgeon is and the responsiveness of the soft tissue. By placing a dorsal graft during a revision rhinoplasty for a nose that has been overresected, the dorsal graft can narrow the nose and widen the middle nasal vault, therefore, correcting an inverted V deformity. This essentially converts a concave dorsum into a straight one. The profile appears more normal when it is straight. Also, a higher dorsum creates an apparently smaller nasal base, despite tip grafts.

Setting the Right Objectives

It is important to establish revision rhinoplasty goals and have a good line of communication with the patient, for example:

  • It is necessary to establish realistic expectations with the patient. Both the patient and the facial plastic surgeon must understand why the original goals were not met. If they were never achievable, the patient and specialist need to work together and develop achievable goals.
  • A well defined aesthetic concept for the correction must be established.
  • It is necessary to defer revision surgery until tissue swelling from the previous surgery is completely resolved, which takes an average of 1 year.
  • A proper diagnosis is necessary. The surgeon must identify which of the anatomic variants were present and what problems have been caused by failing to treat them.
  • It is important to limit the dissection as much as possible to allow the nose to contract better with less scarring.
  • It is better to use autogenous cartilage in patients with thin skin and reserve the use of synthetic biocompatible nasal implants for patients with thick skin.
  • It is important for the surgeon to see the deformity clearly and personally feel it is fixable. If a patient has unrealistic expectations or sees deformities that are not present they should not be operated on.
  • Lastly, surgeons must ensure that their patients accept the margin of error or the possibility of healing improperly that is inherent to any surgery, in particular rhinoplasty surgery.

Correcting Deformities

Revision rhinoplasty aims to correct deformities that either were not addressed in a previous surgery or were the result of poor surgical planning or improper healing after an initial rhinoplasty. Most deformities arising from a rhinoplasty can be categorized. Each deformity has a surgical solution that is usually successful in correcting the problem.

Nasal Dorsal Deformities

Deformities affecting the nasal dorsum after primary rhinoplasty are usually the result of an inadequate or overzealous resection. Surgical errors of inadequate resection are easiest to correct. The surgeon must determine if the excess is in the cartilaginous dorsum or bony dorsum. Overresection may result in deformities that require more skill and work to correct. Surgical errors due to excessive reduction can be challenging and an experienced surgeon is required. Distorted anatomy, decreased vascularity, and scarring complicate revision rhinoplasty. Correction of overresection invariably requires grafts to fill, elevate or contour the deficient areas.

Pollybeak Deformity

Inadequate resection of dorsal septal cartilage, excessive dorsal septal cartilage removal resulting in a dead space in the supratip region, or under-projection of the nasal tip and excessive lower lateral cartilage excision resulting in loss of tip support and underprojection can lead to pollybeak deformity.

If the bony dorsum is excessively reduced, this can result in rounding and fullness of the supratip area. This complication is mostly preventable by exercising proper judgment during the primary rhinoplasty. However, some patients with good structure and poor healing can develop excessive supratip scar tissue and fullness. This tends to occur more in patients with thick skin pre-surgery.

Thicker skinned noses take longer for the swelling to resolve. The use of intralesional steroids in the scar tissue is indicated only if the swelling or deformity is due to scar tissue. It is necessary to palpate the deformity and determine if it is soft or hard. If it is soft then it is scar tissue and is more amenable to steroid injections. Surgical treatment of pollybeak deformity is customized depending on the cause of the deformity.

An inadequately resected dorsal cartilaginous septum or scar tissue can be corrected by trimming excessive tissue through an endonasal approach by putting a unilateral or bilateral intercartilaginous incision. However, tissue must be grafted if it is deficient. Cartilage grafts can be harvested from the septum if it is present or they can be harvested from the ear (concha).

These grafts, if added to the tip, can increase projection and eliminate the pollybeak by raising the tip. A shield graft can also be used to increase projection and eliminate the pollybeak, and can be placed through the endonasal or open approaches.

Saddle Nose Deformity

Relative or true saddle deformity, or scoops in the nasal dorsum, require careful analysis to determine if it is cartilaginous, bony, or a combination in order to properly tailor the surgical revision rhinoplasty accordingly. A saddle nose deformity may result from congenital or traumatic causes, not just surgical.

Surgically-created saddles result from excessive resection of the bone or cartilage or both on the nasal dorsum. It is necessary to evaluate the full nose and its surrounding structures carefully. This is because an apparent saddle may not be a true saddle but instead a relative saddle created by an overprojected nasal tip. In this case, the revision rhinoplasty must deproject the nasal tip in order to achieve nasal and facial harmony.

If there is a true depression in the nose's dorsum, then graft material is required to fill the defect. Septal cartilage, if available, is the best choice for elevating and filling the defect. If a small defect is present, then removing the cartilage is a better option to make it less palpable. Conchar (ear) cartilage and temporalis fascia can also be used to fill the defect where the ear cartilage is covered by the temporalis fascia to become less palpable.

Deeper saddles may require irradiated rib cartilage or a biocompatible implant such as Medpor in order to correct the deformity. Whenever using implants or cartilage grafts, Dr. Rizk points out that the edges must be beveled and smoothed in order to not be palpable. He has developed a method to smooth out cartilage edges with a powered sanding tool.

Alloplastic implants offer an alternative for the correction of severe saddle-nose deformities. The benefits of these implants include: lack of a donor site morbidity, ease of insertion, and a positive aesthetic outcome. Some disadvantages of these implants are infection, rejection, or extrusion, but the risk is minimal.

Properly informed patients usually accept the minimal risk associated with alloplastic implant use, such as with Medpor or Gore-Tex. Medpor and Gore-Tex integrate better into the nose compared to silicon or Silastic implants. Silicone or Silastic implants become encapsulated, have very little tissue integration, and tend to be more mobile. Proper placement of autogenous or alloplastic implants can be performed by creating precise pockets with minimal dissection. The grafts or implants should be soaked in an antibiotic solution before placement. Careful contouring of grafts and implants minimizes irregularities and asymmetries. An open or closed rhinoplasty approach may be used in placing the grafts or implants.

Mid-Nasal Deformities

Perfect nasal symmetry is nonexistent, as everyone exhibits some form of asymmetry. Mid-nasal asymmetries often occur in conjunction with asymmetries or irregularities of the nasal bridge and tip. It is important to assess mid-nasal deformities in relation to the nasal dorsum and nasal tip. Trauma may cause isolated mid-nasal deformities by subluxing the upper lateral cartilage with a possible septal displacement.

A deviated septum may also cause mid-nasal asymmetries if not corrected. Excessive removal of the upper lateral cartilage can also cause irregularities, functional issues, breathing disorders, and a crooked looking nose. Treatment of mid-nasal deformities is directed at the causal problem. Bony irregularities may also contribute to mid-nasal asymmetries.

Septal deformities causing mid-nasal asymmetries require correcting the nasal septum with septoplasty. Treatment of deformities may also require a spreader or onlay graft to correct both a functional issue and cosmetic deformity. Placement of these grafts is performed with the creation of precise pockets with minimal dissection through a unilateral intercartilaginous incision with the endonasal rhinoplasty. Alternatively, the open rhinoplasty approach may be used. Auricular composite grafts may be used if both mucosa and cartilage have been overly resected.

All of these techniques may be performed through an open rhinoplasty approach if direct visualization is desired during graft placement.

Tip and Alar-Columellar Deformities

Tip deformities present some of the most noticeable complications of primary rhinoplasty. Injudicious excisions of the lower lateral cartilage, caudal septum, and soft tissue in the initial rhinoplasty may result in an aesthetic deformity and a functional abnormality as well.

Some common problems include a pinched nasal tip, bossa formation, or alar retraction. Pinching of the alar walls is a sign of over resection of the lateral most portion of the lower lateral cartilage. Therefore, conservative resection of cartilage can prevent this unnatural result. Collapse of the external nasal valve is common in these cases, causing functional breathing issues as well.

Forced nasal inspiration will result in the collapse of the external nasal valve and a pulling in of the lateral nasal wall. Treatment consists of placing cartilage grafts into the deficient areas. Either autogenous septal or auricular cartilage grafts or Medpor alloplastic implants may be used.

Cartilage grafts of the proper size, shape, thickness, and dimension can be harvested and are molded and sculpted with smooth edges. Thick scar tissue is sometimes encountered in this region and may be better elevated by hydro-dissecting it with a local anesthetic. A precise pocket is created so as to be just large enough to admit the graft. Stiffness is an important quality in the grafting for this region in order to hold the skin and provide support. Morselizing or crushing the graft is not a good idea.

Nasal Bossa

These are knob-like protuberances in the region of the dome. They occur most commonly when primary nasal asymmetry required major alteration of the alar cartilage in the initial surgery or from a procedure called vertical dome division where the alar cartilage was divided at the dome. Leaving sharp edges can also lead to bossa formation.

Bossa deformities are hidden initially by tip swelling, though they become evident as the swelling resolves. Overresection of the lobular tip can result in a too-narrow complete strip that may buckle over time. Bossa can be unilateral or bilateral, symmetric or asymmetric.

These deformations are more of a problem and can be visualized more in patients with thin skin. Surgical correction of bossa is performed through an open approach, which is preferable to the endonasal approach. The bossa may be shaved until symmetry is achieved or it may be covered by a septal or auricular graft.

Columella and Alar Retraction

Columellar retraction can occur congenitally after surgery or secondary trauma. Any columellar retraction must be evaluated in relation to the alar-columellar and nasolabial regions. If columellar lengthening is required, a decision is made whether an auricular or composite graft or cartilage alone is needed. To make this determination, inferior retraction is placed on the columella with the thumb and index finger to assess mobility.

If limited mobility is present, then a composite graft is needed. If the columella moves freely, then a graft alone will suffice. If cartilage alone is required, a precise endonasal pocket is created through an incision made at the caudal septal area as the columella is retracted inferiorly. An appropriately shaped graft is sculpted from septal or auricular cartilage and the graft is placed in the created pocket to augment the deficient caudal septum.

In these cases, overcorrection is recommended as postoperative shrinkage may occur. When both vestibular skin and cartilage are deficient, a composite graft is required to lengthen the retraction. The best place to obtain a composite graft is from the posterior conchal skin, which is less adherent to the cartilage but easier to manipulate. The septocolumellar dissection is performed and the composite graft is sutured into the remaining vestibular skin and caudal septum with fine catgut sutures. Columellar and caudal septal reconstruction establishes harmony to the upper lip area, which is an important aesthetic unit.

Alar retraction can be a congenital deformity, but most commonly it is iatrogenic, resulting from a previous rhinoplasty where excessive lobular cartilage and vestibular skin was removed.

To prevent this complication it is important to leave at least 3mm of vestibular skin. An evaluation of the alar-columellar relationship is important as a hanging columella can give the illusion of a retracted ala. If the columella is not hanging and the ala is truly retracted, then a septal or conchal cartilage graft or maybe a composite graft is needed to correct this deformity.

A composite graft is typically reserved for deformity involving both the cartilage and vestibular skin. The concha cymba simulates the shape of the lateral crus best. Cartilage from the ear contralateral to the alar deformity approximates best the curvature of the normal alar.

Determining the Best Approach

To summarize Dr. Rizk’s revision rhinoplasty surgical plan, he frequently uses grafts or implants to correct multiple areas of deformity or collapse. Donor sites may include septum, ear, rib or alloplastic biocompatible implants such as Medpor.

Dr. Rizk custom sculpts the Medpor implant to fit your nose during the procedure. It is not a one size fits all implant. The objectives include:

  • Caudal support grafts to the nasal tip
  • Multiple grafts to recreate projection and tip definition
  • Correcting internal and external nasal valve collapse with spreader and nasal batton grafts
  • Correcting a dorsal saddle nose deformity with either a dorsal onlay graft and/or spreaders
  • Correcting maxillary recession and the drooping nasal tip/long nose syndrome with plumping grafts or maxillary augmentation
  • Correcting a wide nose with proper osteotomies and grafting
  • Treating amorphous, bulbous noses with grafting combined with defatting of thick skin noses
  • Correcting nostril abnormalities, typically the last deformity to be addressed during the revision rhinoplasty

Why Choose Dr. Rizk For Revision Rhinoplasty in NYC?

Dr. Rizk leverages decades of experience, a background in artistry and his meticulous attention to detail to perform revision rhinoplasty procedures that are customized to each patient. His unique eye and understanding of anatomical structure allow him to address the “aesthetic units” with extreme precision and beautiful social presentation.

Dr. Rizk has been featured in national and international media. Please Contact Dr. Rizk today if you are interested in having revision rhinoplasty in New York.

FAQ

When can a revision/secondary rhinoplasty be performed after the previous rhinoplasty?

Typically, it is necessary to wait 1 year for the swelling to resolve prior to doing a revision or secondary rhinoplasty. There are rare exceptions to the rule if there is an obvious deformity that needs to be repaired sooner.

What is a revision/secondary rhinoplasty consultation like?

A patient can expect the following during their consultation:

  • A high definition telescope is used to assess the support structures, the septum, the turbinates and areas of inspiratory collapse. This is also necessary to assess the existence of donor cartilage, which is typically needed in revision rhinoplasty.
  • Pictures are taken of the areas to be addressed during surgery.
  • Computer imaging is done to gain a thorough understanding of potential changes.
  • A CT scan of the nose is ordered.

How long does revision rhinoplasty surgery take?

Generally, revision rhinoplasty at our accredited Manhattan office requires 2.5 to 3 hours or longer, depending on the degree of deformity and the amount of work required to obtain donor tissue. Dr. Rizk believes in thoroughly planning revision rhinoplasty procedures before entering the operating room to increase productivity and reduce surgery time.

How should you prepare for revision rhinoplasty?

Prior to revision rhinoplasty surgery, Dr. Rizk provides patients with pre as well as post-operative instructions. In addition, blood samples are typically needed, as well as medical clearance. To ensure optimal healing, refrain from smoking and drinking before surgery. Also avoid blood thinners such as Aspirin, Motrin, Aleve, and Vitamin E.

How long does it take to heal after revision rhinoplasty?

After revision rhinoplasty in our NYC office, patients can expect to return to work after 1 week. Refrain from heavy exercise for about a month and expect continued nose refinement for one year after surgery.

If my nostrils have been pulled up from a previous rhinoplasty (alar retraction), how does Dr. Rizk correct this deformity?

Alar retraction, which makes the nostrils appear pulled up, usually results from a rhinoplasty where too much cartilage and mucosa was removed. As Dr. Rizk points out, it is important to make sure that a hanging columella does not exist. A hanging columella can give the illusion that the nostrils are retracted. If this is the case, it needs to be corrected prior to evaluating the nostrils. If a true alar or nostril retraction exists, this can be corrected either with a cartilage graft, typically from the septum or ear, or a composite graft of skin and cartilage from the back of the ear.

Can a previous rhinoplasty make my lip appear longer and flatter?

If too much was removed from the bottom part of the nasal septum and the columella is pulled up too much or retracted, then the upper lip can appear flatter and longer. To correct this, an implant or nasal graft called a plumping graft or subnasal graft may be used to push the columella down and lift the upper lip region.

Where will the surgeon obtain grafts or implants to correct deformities?

Often in a revision rhinoplasty following an overaggressive procedure, it is necessary to use pieces of cartilage to support or augment areas of collapse. Dr. Rizk typically employs the use of tissue grafts harvested from the ear, the rib, or the temple region to rebuild the structures of the nose. Other options include rib cartilage from a rib bank, or Medpor, a biocompatible synthetic implant.

How do I select a surgeon for revision rhinoplasty?

Dr. Rizk has established the following criteria for selecting a surgeon for revision or secondary rhinoplasty:

  • Be sure your surgeon has a history of success with revision rhinoplasty and ask to see pictures during your consultation.
  • Be sure your surgeon is a nose specialist or facial plastic surgeon who specializes in the nose and not a general plastic surgeon. It is important to select a nose specialist for primary or revision rhinoplasty since this is one of the most complex procedures in plastic surgery.
  • Be sure your surgeon is board certified by the American Board of Facial Plastic and Reconstructive Surgery. Being certified is important to ensure the surgeon’s expertise in the face and nose, as the board has developed the requirements that need to be met for competency.
  • Ask the facial plastic surgeon if he has patients that you could speak with before your surgery.

What risks are associated with revision rhinoplasty?

As with any surgery, there are risks associated with revision rhinoplasty. Risks include temporary loss of sense of smell, excessive scarring, prolonged swelling, and anesthesia complications, among other potential complications. Dr. Rizk will explain rhinoplasty risks to you prior to your procedure.

Am I a good candidate for revision rhinoplasty?

If you are affected by structural or cosmetic complications from a previous nose job, revision rhinoplasty could help enhance your appearance. By scheduling a consultation with Dr. Rizk, you can find out how to repair a bad nose job and any underlying cosmetic or functional problems.

ADDITIONAL INFORMATION REGARDING REVISION RHINOPLASTY

How Does Dr. Sam Rizk Treat Internal/External Valve Collapse Or Stenosis? Grafts In Rhinoplasty Deformities in Rhinoplasty

Medical Publications

"Correcting the Drooping Tip and Hanging Columella in Revision Rhinoplasty" Chapter in Rhinoplasty Medical Textbook The Drooping Tip

Disclaimer: The images viewed on this page are actual patients of Dr. Rizk who have given consent to show their images on this website. Dr. Rizk respects the privacy of his patients and has blocked the eyes to conceal some of his patient's identities.

Written by Dr. Sam Rizk

Last Modified On: 11/29/2019

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